An Unwelcome Return

(April 11th, 2017) The alarming rise in measles outbreaks across Europe is challenging efforts towards eliminating this contagious disease. Lab Times contacted the WHO Regional Office for Europe to understand the bare facts.

Gone are the days when one spoke of the measles virus in the past tense. Like dinosaurs, it seemed like an ancient relic of the past, an extremely dangerous; but now almost forgotten threat. This member of the paramyxovirus family, that causes a highly contagious infection in the human respiratory tract, has been back in the headlines for all the wrong reasons. The WHO Regional Office for Europe addressed this concern in a recent online press release. Lab Times heard from Robb Butler, the Programme Manager of Vaccine-preventable Diseases and Immunization at the WHO Regional Office for Europe.

First and foremost, let us understand just what the sharp rise in new infections means. Robb Butler explains, “New measles cases in January 2017 and February 2017 are 4.5 times and 3.2 times higher, respectively, than the corresponding months of 2016. As of 4 April 2017, the total number of measles cases in the WHO European Region for 2017 so far is 1,486. The number of cases for the corresponding period in 2016 was 390 while the total number of cases reported for 2016 was 5,133”.

Although, according to the press release, “two-thirds of the Region’s 53 countries have interrupted endemic transmission of measles (…) 14 remain endemic” and seven of these were involved in the new outbreaks. “In all of these countries, estimated national immunisation coverage with the second dose of measles-containing vaccine is less than the 95% threshold.”

Butler clarifies the significance of this, “95% coverage with two doses of measles-containing vaccine is the threshold needed to ensure that an entire population is protected from measles, including those who cannot be immunised, and thus to prevent outbreaks from occurring. As all countries in the WHO European Region have committed to eliminating measles, they should achieve and maintain ≥95% coverage with both doses of measles-containing vaccines in every corner of the country. The second-dose coverage of measles-containing vaccine in the 7 endemic countries mentioned (France, Germany, Italy, Poland, Romania, Switzerland and Ukraine) has varied in the last five years.

“As per the WHO/UNICEF estimates Germany has reported 93% coverage every year since 2010, Italy reported a small decrease to 83% in 2015, Poland decreased to 94% in 2015, and Romania decreased from 93% in 2010 to 88% in 2015, while France, Switzerland and Ukraine improved from 70%, 83% and 41% in 2010 to 77%, 89% and 57% in 2015, respectively. Data show that the coverage in 2015 was below the 95% requirement in all of these endemic countries”, Butler shares.

Why were these countries unable to meet this threshold? Butler says that the reasons for under-vaccination are complex and context-specific. They can be explained, for instance, by inadequate or inequitable access to health services, healthcare workers’ attitudes and false contraindications, parents’ knowledge and beliefs related to vaccination, fear of side effects and conflicting priorities.

What is known about the measles strains causing these re-emerging outbreaks? “Several different measles strains have been reported every year from countries affected by measles in the Region. This includes both endemic strains and strains circulating in other parts of the world. The detection of similar strains in several countries in the Region shows the infectious nature of measles”.

Butler further elaborates, “The information on measles strains, by itself, does not sufficiently indicate the global or regional distribution of the virus. Additional epidemiological data on measles cases should be combined with this data to make valid conclusions on the transmission pathways of measles virus strains. Analysis of available information on genotypes indicates that some measles virus strains are no longer detected in the WHO European Region, thereby suggesting that several long-lasting transmission chains have been interrupted”.

For the WHO, the greatest challenge in containing this health threat is effective vaccination coverage. “Measles is a highly infectious virus and does not respect national borders. As long as measles remains endemic anywhere in the world, the risk of importation will remain high for all countries. The greatest challenge lies in achieving and sustaining vaccination coverage of at least 95% at subnational level by ensuring high demand for vaccination and equitable vaccination services to all,” Butler says.

What can citizens do within their communities besides spreading awareness? “Every individual in a community has a role to play in ensuring protection from vaccine-preventable diseases. This starts with ensuring personal protection as well as protection of every family member. Healthcare workers are especially important advocates for immunisation. They are at the forefront of prevention and control efforts, and as such, they have a critical role in building confidence in vaccines and resilience to misinformation”. Ultimately, “Vaccination is a key tool to prevent suffering and death from measles. Every opportunity should be used by the countries in the European Region to ensure that children and adults are fully protected through the recommended two doses of measles- and rubella-containing vaccine”, sums up Robb Butler.

Latika Bhonsle-Deeng

Picture: Wellcome Images, CC BY 4.0

Last Changes: 05.05.2017